If any penetration, including that from a transvaginal ultrasound, is unbearably painful, it’s likely you have a particular condition that’s often misdiagnosed.
• Have you never been able to have sex due to an agonizing pain that’s like no other?
• Does this even prevent you from inserting a tampon?
• Does it make an internal pelvic exam and Pap smear from your doctor impossible?
• Is the pain absent as long as there is no attempt at any penetration?
• These symptoms perfectly describe vaginismus.
The second the vaginal muscles “detect” that something’s about to make entry, they go into spasm and tighten, narrowing the vaginal entry, making penetration difficult and sometimes impossible.
As the penetration progresses, even if done by your doctor with a pediatric sized swab or speculum, the sensation is that of a knife ripping into a structure full of ultra-sensitive nerve endings, and it feels as though “something” is resisting.
Vaginismus often prevents sexual intercourse between couples. Women with vaginismus have been known to avoid Pap smears at all costs.
Tensing of the vaginal muscles in anticipation of penetration.
Transvaginal Ultrasound: Penetration Unbearable
When a woman with vaginismus (and more times than not, she doesn’t even know it has a name, or has been misdiagnosed) learns she needs a transvaginal ultrasound, it’ll be perfectly understandable if she begins feeling panicky over the procedure.
She herself may be instructed to insert the transducer or “wand” into her vagina.
But there’s little consolation in cases when the technician or doctor inserts.
A transvaginal ultrasound requires the patient to be awake, to respond to the technician’s instructions as far as wand insertion; so heavy sedation is out of the question.
- Vaginismus is the involuntary spasming of the vaginal muscles.
- The key word is “involuntary.”
A woman doesn’t think, “Okay, time to tighten my vaginal muscles.” She has no conscious control over these reflexive muscles; they are not like biceps.
This involuntary spasming will occur when she or someone else attempts to insert the transvaginal ultrasound probe.
Transvaginal Ultrasound Intolerance with Vaginismus: Solutions
“If a transvaginal ultrasound is absolutely necessary such as to view the endometrial lining, then lidocaine cream can be used prior to the ultrasound if vaginal lubricant is not sufficient,” says Mylaine Riobe, MD, founder of Riobe Institute of Integrative Medicine. Dr. Riobe, who’s board certified in ob/gyn and integrative medicine, is the author of “The Answer to Cancer.”
“Lidocaine will cause numbness of the area where it’s applied and is temporary,” continues Dr. Riobe. “Effects will wear off in a few hours.
“How is this accomplished? Lidocaine can be applied with a vaginal applicator very similar to the applicators available for the use of Monistat vaginal creams.”
A laparoscopy is not an option. “Laparoscopy would not be useful to see inside the uterus,” says Dr. Riobe.
“If you’re looking for uterine fibroids, a transabdominal U/S can be done and avoid the need for transvaginal U/S.” This can also be used to look at the ovaries.
“MRI can also be used to visualize fibroids and certain types of uterine anomalies.
“A hysteroscopy can be done to visualize the inside of the uterus, but requires some form of analgesia and is more invasive than U/S.”
What about Kegel exercises?
“I do not generically recommend Kegels to people with vaginismus,” says Heather Swain, PT, DPT, owner of Ally Total Physical Therapy.
“In fact, they can actually be harmful.” Heather points out that gynecologists “sometimes generically recommend Kegels.
“Many do not know what pelvic floor physical therapy is.
“Studies actually suggest that even when provided with a handout on how to perform Kegels, 40% of patients will do them incorrectly, and 25% will do them in a way that worsens their condition.
“The majority opinion in the pelvic floor physical therapy community is that it is important to evaluate a patient’s symptoms fully before prescribing a treatment.
“To prescribe Kegels without first testing the muscle strength and function doesn’t make sense.
“It would be like prescribing someone blood pressure medication without first taking their blood pressure to see if it’s high.
“Vaginismus is often associated with elevated muscle tone in the pelvic floor muscles.
“That means that the muscles are contracted and are too tight.
“When performing a Kegel exercise, the goal is to contract your pelvic floor muscles more. That is actually the opposite of what most vaginismus patients need.”
Dilator Therapy
Dr. Swain recommends “graded approach desensitization – gradually increasing tolerance for penetration with smaller objects (typically the gloved finger of a pelvic floor therapist, or a dilator), and working up to larger objects (typically a dilator).”
A vaginal dilator kit may be intolerable for some women, however, as it involves practicing self-penetration.
Furthermore, her doctor may want the ultrasound done very soon — before “training” with the kit would make a big difference.
Additional Tips for Making a Transvaginal Ultrasound Tolerable if You Have Vaginismus
Dr. Swain recommends the following.
“Biofeedback therapy – helping improve patient awareness of what their pelvic floor muscles are doing and gain control of them.
“Teaching relaxation of the pelvic floor muscles – cuing for how to lengthen the muscles and utilization of breathing techniques.
“Once this is mastered, we attempt to teach patients how to actively relax the muscles during penetration.
“Manual therapy techniques to stretch the pelvic floor muscles and release muscular trigger points.
“Pelvic and hip stretching exercises. Strengthening of other muscles to reduce the load placed on the pelvic floor muscles.
“Bowel and bladder retraining – chronic constipation, or not urinating all day, means your pelvic muscles have to carry more weight on them and hold tight to restrict the leaking of urine or stool.
“Other bad habits like straining to pass bowel movements can also make things worse. Sometimes we retrain these things in order to improve vaginismus.”
A really good trick to make a transvaginal ultrasound more tolerable is to get acquainted with a woman’s female anatomy.
Once you see that there is nothing “resisting” the penetration of a swab or wand, and instead it’s just an illusion created by spasming muscles compressing upon the inserted tool, you’ll be able to relax better.
Also ask the technician or doctor to narrate what she’s doing every step of the way during your transvaginal ultrasound. This will really help.
“Establish expectations with the provider,” says Dr. Swain.
“How much do you want them to tell you in advance about what they are doing? Some people want warning before they move to a greater penetration depth.
“Breathe through it. As you inflate your belly with air and take a deep diaphragm breath, your pelvic floor muscles relax more.”
In fact, ask the doctor to alert you each time they progress further with the penetration, so that simultaneously, you can inhale deeply.
If you’re tempted to order to the provider, “Take it out!” then cover your mouth, clench your teeth, take deep breaths, whatever it takes to prevent those words from escaping your mouth.
Think to yourself, “It’ll be over in just a few minutes. Hang in there.”
Nevertheless, you DO have a right to order the provider to withdraw the instrument at any time.
Keep in mind that total relaxation is a must. See if you can go from “emotional mode” to “Vulcan mode.”
Vulcan is the iconic species from the “Star Trek” franchise.
This humanoid species suppresses emotion during stressful, even terrifying circumstances, and instead becomes tactical, strategic and calm.
Logic, not fear, rules. This approach can help relax the vaginal structures.
Let your body go limp. Tensing up from anxiety will only make the vaginal muscles angrier during a transvaginal ultrasound or Pap smear.
Ally Total Physical Therapy
